The food supply is known to have a substantial impact on greenhouse gas emissions. The Global Warming Potential Star (GWP*) refers to the amount of carbon dioxide equivalents produced by food items, and can be used to quantify the impact of the food supply on the environment. GWP* values are available for n = 232 Australian food products(1). In order to estimate the climate footprint of diets in Australia, GWP* values must be applied to all foods in AUSNUT 2011–13, the most current Australian food composition database. The aim of this study was to systematically apply GWP* values to foods in AUSNUT 2011–13, to facilitate calculation of the climate footprint of Australian dietary data. To create the GWP*-AUSNUT 2011–13 database, all n = 5740 food and beverage items in AUSNUT 2011–13 were reviewed, and GWP* values were applied via a systematic approach. Initially, GWP* values were matched to AUSNUT 2011–13 foods based on conceptual similarities, where an appropriate GWP* item existed (e.g., Beef, mince, < 5% fat, raw was matched to the GWP* item ‘Beef meat’, with a GWP* value of 16.68 CO2e/kg). For AUSNUT 2011–13 foods where there was not an appropriate GWP* item, for example composite foods with multiple ingredients, the AUSNUT 2011–13 Recipe File was used to determine constituent ingredients and match these to GWP* items (e.g., Beef, mince, < 5% fat, baked, roasted, fried or stir-fried, grilled or BBQ’d, canola oil was matched to the GWP* items ‘Beef meat’ and ‘Canola oil’ based on the ingredient proportions in the AUSNUT 2011–13 Recipe File). Where an AUSNUT 2011–13 recipe did not exist, these were determined based on ingredient descriptions in the AUSNUT 2011–13 database, or based on ingredient proportions from a sample of food labels (e.g., Peanut butter, smooth & crunchy, added sugar & salt). In the case of single ingredient foods without an appropriate GWP* item match, an average of GWP* values for similar foods (using the AUSNUT 2011–13 food classification categories) was calculated (for example as there was no GWP* item for Mulberry, raw, an average of all GWP* items aligning with foods in the AUSNUT 2011–13 minor food group ‘berry fruit’ was calculated). The systematic process of applying GWP* values to AUSNUT 2011–13 foods was conducted by two researchers independently, with any disagreements resolved via consensus and discussion with the research team. Through application of GWP* values to the AUSNUT 2011–13 food composition database via a systematic process, the GWP*-AUSNUT 2011–13 database was created. This database will allow for the estimation of the climate impact from dietary data collected in Australia, both retrospectively and in future studies, to identify the climate footprint of different dietary patterns or to provide insight into dietary changes required to decrease greenhouse gas emissions.

Evidence of epigenetic risk of metabolic syndrome (MetS) from both parents, and its increasing prevalence globally, underscores the necessity for effective lifestyle interventions preconception. Despite this, very few studies have examined couples-based interventions and those which are concerned with foetal health rarely monitor paternal health outcomes(1). This study evaluates the feasibility and adherence of a 10-week couples-based lifestyle intervention targeting diet and physical activity. Utilising an exploratory sequential mixed methods design, the study recruited 16 participants (8 couples) aged 18–44 years, living together with a BMI between 18.5 and 38 kg/m². Participants received personalised dietary and physical activity guidance aligned with national guidelines, with progress tracked via the Easy Diet Diary app and the International Physical Activity Questionnaire (IPAQ). Quantitative data were collected at baseline, mid-point, and end of the intervention, while qualitative insights were obtained through semi-structured interviews post-intervention. The intervention aimed to leverage the natural support system within couples to enhance adherence to healthy lifestyle behaviours. Quantitative findings indicated positive trends in reducing sedentary behaviour by an average of 1105 minutes per week and increasing vegetable consumption by 1.7 servings per day. Participants also showed improvements in BMI and waist-to-hip ratios, with significant reductions noted by the end of the intervention. Qualitative data and thematic analysis provided rich context to these findings and underscored the importance of mutual support, shared responsibility, and accountability in fostering adherence, but also indicated a need for more flexible and user-friendly tracking tools. Partner encouragement, joint activities such as meal planning, exercising together, and shared responsibility emerged as significant adherence enhancers while differing timing and work schedules were a common barrier. This study demonstrates that a couples-based approach can effectively enhance adherence to lifestyle modifications, promoting significant behavioural changes and improving health outcomes by leveraging the inherent support system within the relationship, thereby facilitating more sustainable health behaviours. Future research should explore long-term impacts and optimise intervention strategies to address identified challenges, ensuring broader applicability and effectiveness in diverse populations. The promising results of this feasibility study advocate for the potential scalability of couples-based interventions as a public health strategy to combat MetS and related conditions.

Previous studies have shown the health benefits of daily total protein intake(1), yet temporal protein patterns in the population have rarely been investigated. The currently available studies have examined the associations between total protein intake at eating occasions (EOs) with cardiometabolic(2) and muscular health(3) but have not accounted for different protein sources. This study aimed to describe temporal patterns of total, plant, and animal protein intake at EOs in Australian adults, and to examine these patterns according to their sociodemographic and eating pattern characteristics (e.g., meal and snack frequencies, amount of protein intake). Using the 2011–12 Australian National Nutrition and Physical Activity Survey data, this study included adults aged ≥ 19 years who completed one 24-hour dietary recall (n = 6741). Total, animal and plant protein intake at self-reported EOs was estimated using the AUSNUT 2011–13 nutrient database and Australian Dietary Guidelines (ADG) food classification system(4). Plant protein included grains, nuts, and other plant-based, protein-containing foods, while animal protein consisted of meats, dairy, and other animal-source foods. Separate latent variable mixture models were used to identify temporal patterns of total, animal, and plant protein based on hourly intakes of total, animal, and plant protein, respectively. Pearson’s Chi-square test (for categorical variables) and one-way analysis of variance (for continuous variables) were used to examine the differences in participant characteristics between latent classes of temporal protein patterns. Three latent classes for men’s and women’s intake of total, animal, and plant proteins were identified. Class 1 was characterised by high probabilities of consuming protein at the usual Australian mealtime (e.g., dinner at 18:00–19:00h), and participants in this class were significantly older than the other two classes (all, p < 0.001). Class 2 had a high probability of eating protein an hour later than the mealtime of Class 1 and the highest protein intake from meals (all, p < 0.001), except for men’s total protein and women’s plant protein. Participants in Class 2 of total (all, p < 0.001), animal (all, p < 0.001), and plant protein (women only, p = 0.02) were characterised by high income and employment status. Participants in Class 3 had the lowest meal frequency (all, p < 0.001) and the lowest total, animal, and plant protein intakes from meals (all, p < 0.001), but the highest intakes from snacks (p < 0.001), except for women’s animal protein intake. Most adults in Class 3 of total (men only, p < 0.001) and animal protein (all, p < 0.001) also had high education level, lived in urban areas, and were not married. Three temporal protein patterns with distinct characteristics were identified in this study. Future studies need to investigate whether these temporal protein intake patterns are associated with health outcomes.

Micronutrient malnutrition is a public health concern in many developing countries including Sri Lanka. Rural poor households are more vulnerable to micronutrient malnutrition due to their monotonous rice-based diet, which lacks dietary diversification(1). Despite the potential of home gardens on increased food access and diversity, their contribution to household dietary diversity remains unclear. This study aimed to investigate the impact of home gardens on diet diversity among rural Sri Lankan households. Low-income households with children under five were randomly selected from the Samurdhi beneficiary list, and 450 households having a home garden agreed to be interviewed. We collected information on types of crops and livestock produced over the past 12 months and their utilisation. We also collected the socio-demographic characteristics of the households. We measured household dietary diversity using the Household Dietary Diversity Score (HDDS) based on FAO guidelines. Multiple linear regression was used to identify the predictors of HDDS. Complete data sets were only available for 411 households and were included in the analysis. The HDDS ranged from 3 to 10 with a mean of 6.4 (±1.37 SD) indicating a moderate level of dietary diversity. However, only 20.4% of the households met the adequacy threshold, which is higher than the third quartile(2). Cereals, and fats and oils were the only food groups consumed by all the households. Although many households produced fruits (67.2%) and reared livestock (48.2%), the consumption of these groups were the lowest among the 12 food groups. Predictors of HDDS included monthly household income which had a strong positive relationship, especially earnings above 35,000 LKR (β = 1.02; S.E = 0.246; p = 0.000). Surprisingly, living far from the market was associated with increased HDDS (β = 0.026; S.E = 0.008; p = 0.004). Conversely, living further away from the main road reduced the HDDS (β = −0.133; S.E = 0.049; p = 0.007). Growing staples reduced the HDDS (β = −0.395; S.E = 0.174; p = 0.023), whereas growing leafy vegetables increased the diet diversity (β = 0.394; S.E = 0.154; p = 0.010). Selling homegrown products also increased HDDS (β = 0.276; S.E = 0.136; p = 0.043). However, other covariates such as the education level of the female adult, household food security status, home garden yield (kg), and livestock richness, which showed significant correlation in the bivariate analysis did not significant in the multiple regression analysis. Although all households in this district engage in some form of home gardening, 79.6% of households did not have adequate dietary diversity. There is a need to understand how home gardens can better contribute to dietary diversity.

Optimal nutrition supply to the developing foetus is paramount in achieving appropriate foetal growth and development. The Australian dietary guidelines advise about the amounts and types of foods for pregnancy(1). However, previous studies in reproductive aged women(2) and in pregnant women(3) showed suboptimal adherence to dietary recommendations. There is no evidence on the experience of sourcing nor uptake of the dietary guidelines among pregnant women. The aim of this study is to qualitatively explore women’s knowledge and understanding of nutrition information for pregnancy, including the current Australian dietary guidelines for pregnancy. Twelve pregnant women were recruited from a longitudinal study from the first through third trimester of pregnancy. Purposive sampling was adopted with an intention to recruit for diverse health information seeking habits. Semi-structured interviews were conducted with women at different trimesters, transcribed verbatim, and analysed thematically. Three themes were generated regarding information sourcing, uptake and evaluation. (i) Women had limited knowledge about the pregnancy dietary guidelines, leaving them to source pregnancy related nutrition information elsewhere. (ii) Women described other healthy eating advice that contributed to confusion and potential incompatibility with their dietary beliefs and lifestyle practices. (iii) Women shared that they were capable of seeking and evaluating the identified dietary advice, but the inconsistency across information sources contributed to over-cautious behaviour and dietary restrictions. Our findings suggest there is a general lack of awareness of the official dietary guidelines for pregnancy. To optimise pregnancy nutritional intake, efforts should be made to increase utilisation of the Australian dietary guidelines for pregnancy and to support uptake of dietary advice among pregnant women.

Nutritional metabolomics is an emerging objective dietary biomarker method to help characterise dietary intake. Our recent scoping review identified gaps and inconsistencies in both design features and level of detail of reported dietary intervention methods in human feeding studies measuring the metabolome(1) and our cross-over feeding study protocol details dietary information for identification of metabolites that characterise ‘healthy’ and ‘unhealthy’ (typical) Australian diets(2). The current study aimed to gain consensus on core diet-related item details (DID) and recommendations for reporting DIDs to inform development of a reporting checklist. The aim of this checklist is to guide researchers on reporting dietary information within human feeding studies measuring the dietary metabolome. A two-stage online Delphi was conducted encompassing 5 survey rounds (February–July 2024). This study is approved by the University of Newcastle’s Human Research Ethics Committee (HREC; H-2023-0405). Sixty-seven experts were invited across expertise in clinical trial design, feeding study intervention implementation, metabolomics, and/or human biospecimen analyses. Twenty-eight DIDs categorised across five domains underwent consensus development. Stage 1 (2 rounds) gained consensus on a core set of DIDs, including phrasing. Stage 2 (3 rounds) gained consensus on standard reporting recommendations for each DID and acceptance of the final reporting guideline. The research team convened after every round to discuss consensus-driven results. Experts resided from Australia, New Zealand, United States, United Kingdom, Sweden, Israel, Italy and Denmark. Twenty-five completed stage 1 and n = 22 completed stage 2. After stage 1, two DIDs merged and two new DIDs were identified, totalling 29 core DIDs. At the end of stage 2, round 2, based on expert feedback, all items were organised to determine differing degrees of reporting in the methods section of publications, with additional recommendations collated for other sections, including supplementary files. The reporting guideline (DID-METAB Checklist) was generated and accepted by the expert working group in round 3, with all experts agreeing that relevant journals should include the checklist as a suggested reporting tool for relevant studies or used alongside existing reporting tools. The Delphi process gained consensus on a core set of DIDs, and consolidated expert views on the level of detail required when reporting DIDs in research. The Delphi process generated the reporting guideline (DID-METAB Checklist) which can be implemented independently or as an extension to existing guidelines such as CONSORT (at item 5) or SPIRIT (at item 11) to improve reproducibility and comparability of feeding studies. Endorsement by scientific societies and journals will be key for the dissemination strategy and optimising the utility of the tool to strengthen the evidence base of nutritional metabolomics. The DID-METAB Checklist will be a key tool to advance reporting of diet-related methodologies in metabolomics for both personalised and precision nutrition interventions in clinical practice.

Improving neonatal piglet survival is a key driver for improving pig production and enhancing animal welfare. Gestational diabetes is a risk factor for neonatal morbidities in humans, such as hypoglycaemia and respiratory distress(1). There is limited knowledge on the association of gestational diabetes with neonatal survival in commercial pigs. An early study suggested that the diabetic condition of late-gestating sows was positively correlated with the first-week newborn piglet mortality(2). Genetic selection in recent decades for heavier birth weight may have increased the prevalence or severity of gestational diabetes in pigs, considering the positive correlation between gestational diabetes and birth weight. We hypothesised that the diabetic condition of late gestating sows positively correlates with the neonatal piglet mortality rate in sows with modern genetics. Mixed-parity sows (1.5 ± 1.6 parity for mean ± standard deviation (SD); Large White × Landrace) from a commercial piggery in Australia were randomly selected and participated in an oral glucose tolerance test (OGTT) during two seasons (118 sows in winter and 118 sows in summer). On the d109 day of gestation, sows were fed 3.0 g dextrose per kg of metabolic body weight after fasting overnight. Tail blood glucose concentrations were measured using a glucometer (Accu-Chek ®, Roche Diabetes Care Australia Pty) at −10, 0, 10, 20, 30, 40, 50, 60, 70, 80, 90, 105, 120 minutes relative to dextrose feeding. The glucose increment (2.5 ± 1.29 mM for mean ± SD) during OGTT was calculated using the maximum concentration substrating the fasting concentration of blood glucose. The 24-hour piglet mortality rate (5% ± 8.8% for mean ± SD) was calculated as the ratio between piglets that died during the first 24 hours and the total number of born alive on a litter basis. The effect of sow glucose increment, season (winter vs summer), glucose increment × season, number of piglets born alive, and sows parity on the 24-h piglet mortality rate as analysed using a Generalised Linear Model (SPSS 27th Version, IBM SPSS Statistics, Armonk). Results showed that the 24-hour piglet mortality rate was numerically higher in winter than in summer although insignificant (5.7% vs 4.2%, p = 0.41). The glucose increment of gestating sows was positively correlated with the 24-hour piglet mortality rate during winter but not summer, as evidenced by an interaction trend between glucose increment and season (p = 0.059). The regression coefficient suggested that every extra unit (mM) of glucose increment during OGTT corresponded to a 1.4% increase in the 24-hour piglet mortality rate in winter. In conclusion, the diabetic condition of late-gestating sows is a risk factor for neonatal piglet mortality in winter. Developing nutritional strategies to mitigate the diabetic condition of late-gestating sows may benefit neonatal piglet survival.

Objective biomarkers of a healthy and typical Australian diet could enhance dietary assessment and provide insight into how adherence to, or deviations from, dietary guidelines impact health. This study aimed to identify and compare plasma and urinary metabolites in healthy Australian adults in response to a healthy and typical dietary pattern. This was an 8-week randomised, cross-over feeding trial(1). After a two-week run-in period, participants were randomly allocated to follow each diet for two weeks, with a minimum two-week washout period in between. The Healthy Australian Diet adhered to the Australian Dietary Guidelines(2), including a balanced intake of the five food groups and meeting Acceptable Macronutrient Distribution Range targets(3). The Typical Australian Diet was formulated based on apparent consumption patterns in Australia(4). During each feeding phase, all food items were provided to ensure compliance. Both diets included different key indicator foods associated with known metabolites. Comprehensive data collection occurred at four key visits: week 0 (end of run-in; baseline 1), week 2 (post-feeding phase 1), week 4 (end of washout, baseline 2), and week 8 (post-feeding phase 2). Blood samples following a ≥ 8-hour fast were collected by an accredited pathologist, and spot urine samples were self-collected by participants at the morning appointment. Metabolomics data was obtained using Ultra-high Performance Liquid Chromatography-Tandem Mass Spectrometry (UHPLC-MS/MS) through Metabolon Inc.’s (Morrisville, USA) Global Discovery Panel. Metabolite concentrations were log-transformed. Differential changes in metabolites between intervention groups were evaluated using linear mixed-effect models, adjusting for diet sequence, feeding phase, and subject ID as a random variable to account for potential autocorrelation. Post-hoc pairwise comparisons were conducted to assess the impact effects of each diet. A total of 34 healthy Australian adults (age 38.4 ± 18.1 years, 53% females) completed all study measures. After adjusting for multiple comparisons, significant differences between TAD and HAD groups were observed for 257 plasma and 91 urine metabolites. Of these, 44 known metabolites consistently differed between dietary pattern groups in both biofluid types (plasma and urine). Several associations between specific food groups and metabolites were identified, including the externally validated metabolites associated with dark chocolate (theobromine), orange juice (proline betaine), and cruciferous vegetables (S-methylcysteine sulfoxide, S-methylcysteine). Consumption of dietary patterns aligned with Australian dietary guidelines had a measurable impact on the short-term human metabolome compared to a typical Australian dietary pattern. While some metabolites are established as biomarkers of specific foods, others may represent novel biomarkers requiring validation in future clinical trials and diverse populations. Further research should explore the relationship between these metabolites, the gut microbiome, and clinical outcomes. Additionally, studies are needed to assess the feasibility of using these biomarkers to evaluate diets in real-world settings.

Immunoceuticals are natural products used to enhance immunity(1). Lactoferrin (Lf) is an immunoceutical supplement which has been shown to have immunomodulatory properties(2). The immuno-protective functions of Lf are of interest in older adults, as immune function declines with increasing age(3). This study examined the effects of oral Lf supplements on ex vivo immune cell responses to respiratory virus infection, circulating immune cell subsets, and systemic inflammation. Healthy adults (≥ 50 years old, n = 103) were randomised to High dose (600 mg/d) or Low dose (200 mg/d) Lf or placebo, in a 4-week, parallel, double-blinded trial. Ex vivo cytokine release of interferon (IFN)-α2, IFN-γ, interleukin (IL)-6 and tumour necrosis factor (TNF)-α) in isolated peripheral blood mononuclear cells (PBMCs) infected with rhinovirus A-16 (RV-16) and influenza A virus (H1N1), circulating immune cell subsets, and plasma IL-6, C-reactive protein (CRP) and TNF-α were assessed and analysed by multivariate regression models. Analysis included 102 participants at baseline, and 96 participants at follow up. High dose Lf decreased RV-16-induced IL-6 (p = 0.001 vs placebo), and increased RV-16-induced IFN-α2 (p = 0.041, vs low dose) in PBMCs. H1N1-induced IL-6 decreased following Low dose Lf and placebo (p = 0.009, p = 0.021 vs baseline), while High dose Lf increased H1N1-induced TNF-α (p = 0.023 vs low dose, p = 0.049 vs placebo) and decreased H1N1-induced IFN-γ (p = 0.032 vs baseline) in PBMCs. High dose Lf increased total T cells (p = 0.031), CD4+ T cells (p = 0.028) and BDCA-1 cells (p = 0.016), and decreased γδ T cells (p = 0.046) compared to placebo, while Low dose Lf reduced circulating neutrophils (p = 0.044), natural killer cells (p = 0.045), activated CD8+ T cells (p = 0.031), and γδ T cells (p = 0.031) compared to placebo. High dose Lf decreased plasma IL-6 and CRP compared to Low dose Lf (p = 0.004, p = 0.026), but not placebo. There was no difference between intervention groups in the number of adverse events. This 4-week trial in healthy, older adults showed both High and Low dose Lf interventions enhanced ex vivo immune cell responses to respiratory virus infection, with decreased pro-inflammatory cytokine and increased anti-viral cytokine release observed. Low dose Lf reduced the frequency of both pro-inflammatory and cytotoxic innate immune cells, while increased T-cell populations following High dose Lf indicate improved cellular adaptive immune responses which provide protection against infection, tumours and chronic disease. Effects on systemic inflammation were only seen following High dose Lf, suggesting higher doses of lactoferrin are required to address this outcome. Oral lactoferrin supplements are generally regarded as safe, and appear to have immunoceutical benefits in healthy, older adults.

New South Wales (NSW) Health is committed to enhancing child health and development during the first 2000 days (conception to 5 years)(1). However, in Australia current child health behaviours indicate the need for further improvements. For example, discretionary foods (contributing high amounts of saturated fat, energy, added sodium and sugar) account for approximately 30% of total energy intakes in 2–3 years olds including the consumption of sugar sweetened beverages (SSB)(2). There remains a need to provide all parents raising children with direct and sustained support from birth to maximise health behaviours during this important life stage. Healthy Beginnings for HNEKids (HB4HNEKids) is an innovative text messaging program designed to be integrated into the usual care provided by Child and Family Health Nursing (CFHN) services. The messages were co-designed with key stakeholders to provide age-and-stage relevant preventive health information to parents/carers during the first 2000 days. HB4HNEKids has been piloted within five diverse CFHN services within the Hunter New England (HNE) local health district of NSW, reaching over 6000 families since its launch. However, the efficacy of the program on child health behaviours has not yet been explored. The aim of this study is to explore if families that received the HB4HNEKids program report reduced frequency of child discretionary food intake and a lower prevalence of SSB exposure, compared to families who did not receive the program. A cross-sectional survey of mothers 12–14 months post-partum was conducted between August 2023 and July 2024 including participants that received HB4HNEKids and a concurrent non-randomised comparison group, located in HNE. Mothers were asked to report on the frequency of child discretionary food intake per week, and whether their child had ever received SSB (including sweetened water, cordial, fruit drink, and soft-drinks). We conducted linear regression and logistic regression analyses to explore differences between the intervention and comparison participants. A total of 283 participants completed the survey, including 104 (37%) participants that had received the HB4HNEKids program. In infants aged 12–14 months, the frequency of discretionary food intake was approximately 1 serve per week and was unchanged based on if the family had received the HB4HNEKids program or not. Despite a 6-point prevalence difference in SSB exposure reported between groups (HB4HNEKids: 19.42% vs Comparison: 26.26%), this difference was not statistically significant (OR: 0.68 (95% CI: 0.37, 1.23), p = 0.2). Australian infant feeding guidelines suggest that the consumption of nutrient poor discretionary foods and sugar sweetened beverages should be avoided or limited(3). The HB4HNEKids program demonstrates some promise for improving infant feeding behaviours, however a larger effectiveness trial is required to ensure the evaluation is adequately powered.

Polycystic ovary syndrome (PCOS) is a common endocrine condition(1) associated with an increased risk of developing type 2 diabetes (T2D) and cardiovascular disease. Healthy lifestyle habits are critical in the management of PCOS(1), however, the public health system provides limited support for the lifestyle management of PCOS. Diabetes Victoria delivers a free program, ‘Life!’, to Victorian Residents at high risk of developing T2D, including those with PCOS. Life! is currently designed to meet general high-risk population needs, not specifically designed with PCOS in mind. This study aimed to evaluate the current Life! Program’s design, content and delivery against the needs of those with PCOS through co-design workshops with previous Life! participants who have PCOS (n = 14) and program facilitators (n = 5). A series of mixed-methods workshops were used to assess the current program, design an ideal program and prioritise unmet needs. Co-design was informed by the Linking and Amplifying User-Cantered Networks through Connected Health (LAUNCH) Roadmap(2) and the TiDiER checklist(3). Online worksheets, polls, open-ended questions and annotation of current material were used to aid participation and input. Four workshops (WS) were conducted online: two 3-hr (WS 1) and two 2-hr (WS 2). All were audio recorded and transcribed. Data was thematically synthesised using template analysis and findings from WS 1 were used to inform WS 2. Those with PCOS participated in the Life! program between 2018 and 2023, were aged between 24 and 52 years and the majority (93%) had a BMI greater than 25kg/m2. Program facilitators included dietitians, diabetes educators and a physiotherapist with 80% having more than 10 years’ experience. Overall participants wanted less generic and more PCOS-centric topics, less of an emphasis placed on weight loss with an equal focus on a range of health outcomes. Recommended topics included PCOS-centric lifestyle advice across diet, physical activity, sleep and mental health with an emphasis on how (practical strategies) and why (mechanistic understanding) healthy lifestyle behaviours should be applied. Participants desired the tone and sentiment used in the program’s language and imagery to be inclusive, gentle, non-stigmatising and positive. Participants desired a flexible approach to program delivery (a mix of in-person, online, one-on-one and group). One-on-one sessions were desired when receiving individualised advice and discussing sensitive topics, while group sessions were preferred for peer support, learning activities and reflections. People with PCOS desire a PCOS-centric lifestyle program with a focus on meaningful health outcomes, reducing the focus on weight loss, blended delivery, tailored and practical strategies with long-term support. Results will inform the development of a tailored lifestyle program that aims to better engage those with PCOS. Future community-based PCOS programs and clinicians are strongly recommended to incorporate these findings to improve engagement and consumer satisfaction.

Obesity affects > 30% of Australian adults and is a rapidly growing health concern, on both national and global scales(1). Obesity is associated with an excess of nutrients in the circulation, particularly saturated fatty acids which are thought to contribute to chronic low grade systemic inflammation(2). People with obesity are also known to have an increased risk of severe respiratory viral disease, highlighted by both the recent SARs-CoV-2 pandemic and the 2009 Influenza A H1N1 pandemic(3,4). Previously, our group has shown that consuming a meal high in saturated fatty acids can increase activation of the NLRP3 inflammasome in the airways of adults with asthma(5), while others have shown increased NLRP3 activation is implicated in the pathogenesis of severe inflammation observed during the peak of IAV-induced lung disease(6). We sought to determine the impact of dietary saturated fatty acids on the immune response of airway epithelial cells to Influenza A Virus, and to examine if this is a factor for severe respiratory viral disease outcomes. We pre-treated BCI-NS1 cells, an airway epithelial cell line, with either media or physiologically relevant concentrations of the saturated fatty acids, palmitic acid (250 μM), stearic acid (1000 μM) or pentadecanoic acid (50 μM) for 3 hours at 37°C (5% CO2). Cells were then washed with phosphate buffered saline and infected with Influenza A (H1N1pdm09) (Multiplicity of Infection 0.5) and incubated for 48 hours at 37°C (5% CO2). Cell culture supernatants were collected and assayed by Enzyme-Linked Immunosorbent assay for Interleukin (IL)-6 and Interferon (IFN)-λ. Pre-treatment with saturated fatty acids reduced IFN-λ production of virus infected cells (following palmitic acid pre-treatment IFN-λ was 7.9 pg/mL ± 4.5 (SD); n = 6, p < 0.01, following stearic acid pre-treatment IFN-λ was 10.3 pg/mL ± 7.7 (SD); n = 6, p < 0.01, and following pentadecanoic acid pre-treatment IFN-λ was 11.3 pg/mL ± 8.1 (SD); n = 6, p < 0.01, compared to cells pre-treated with media alone (42.7 pg/mL ± 14.0 (SD); n = 6). IL-6 production was unchanged by pre-treatment with saturated fatty acids prior to H1N1pdm9 infection. As previously mentioned, the excess saturated fatty acids are correlated with chronic low-grade systemic inflammation(2). This is thought to be of contribution to the worsened infection-induced outcomes in response to Influenza A. We conclude that dietary saturated fatty acids circulating in people with obesity may impair the anti-viral response of airway epithelial cells and further contribute to severe outcomes in respiratory viral disease experienced by those with obesity.

Between 2015 and 2017, East Arnhem Land recorded the highest rates of avoidable deaths in Australia.(1) In 2018, coronary heart disease emerged as the leading cause of avoidable death among First Nations people, with poor diet contributing to 50% of the total burden.(2) Yolŋŋu people in East Arnhem Land are aware of the health challenges and actively seek community-led support from organisations to create health-promoting food environments. The Arnhem Land Aboriginal Progress Corporation (ALPA), governed by a Yolŋu Board of directors, operate six grocery stores in East Arnhem Land. Through analysis of store sales data more than half of total sugar sales are attributed to table sugar. Despite the successful implementation of strong nutrition policies across their retail stores, which have significantly reduced the sale of sugary products like soft drinks, lollies, and cordial, there has been limited success with reducing purchasing of table sugar. Overall, free sugars from all sugar products purchased remains above the World Health Organization’s recommendations. To tackle this public health issue, the Heart Foundation, in collaboration with ALPA and Miwatj Health Aboriginal Corporation, have embarked on a project aimed at reducing table sugar consumption in East Arnhem Land. Consultations with community members and health professionals in Galiwin ‘ku and Milingimbi were held from July 15 to 19, 2024, to assist in the co-design of culturally relevant nutrition resources. Microsoft Teams was utilised for recording and transcription, and artificial intelligence software for thematic analysis. The consultations explored community perceptions of table sugar, its use, and its health impacts. It was identified that sugar consumption is deeply ingrained, particularly in tea drinking, where large quantities of sugar are consumed daily. The addictive nature of sugar was acknowledged, making it challenging to reduce intake. Thematic analysis revealed that while there is an awareness of sugar’s harmful effects, such as its links to heart disease and diabetes, challenges like food insecurity, addiction, and ingrained consumption habits persist. Community members preferred resources that are culturally sensitive, employ positive storytelling methods, and use both modern (Youtube, TikTok, Instagram and Facebook) and traditional (posters in stores and clinics) media. Suggested strategies included emphasising gradual reduction techniques and involving community to enhance the authenticity of resources. Draft resources will be further refined through a second round of community consultations in late October 2024, with final versions distributed by the end of the year and accessible on the Heart Foundation’s website. Success will be measured through ALPA store sales data on table sugar, website engagement, and social media metrics. This initiative seeks to promote sustainable behaviour change and improve health outcomes in East Arnhem Land.

Pre-school children’s dietary intake in Australia is substandard, with only 18% of children aged 2–3 years meeting the recommended intake for vegetables, and more than one-third of their daily kilojoules coming from energy-dense, nutrient-poor foods. Several child eating behaviour traits (e.g., food fussiness, enjoyment of food, satiety responsiveness and food responsiveness) are associated with the dietary intake of pre-school children(1). However, the associations between child eating behaviour traits and overall dietary quality in pre-school children have not been examined, which is important as children do not consume food groups or nutrients in isolation. It is also important to understand how biological factors such as age may influence child eating behaviours, given that eating behaviour traits such as food fussiness can develop and change with age(2). Therefore, the aims of this study were to examine the associations between preschool children’s eating behaviour traits and their dietary quality and to examine the moderating effect of children’s age on these associations. Cross-sectional survey data was collected online from mothers of pre-school aged children (2–5 years) from across Australia. The Children’s Eating Behaviour Questionnaire (CEBQ) measured four child eating behaviour traits: food fussiness, enjoyment of food, food responsiveness and satiety responsiveness. A validated thirteen-item food frequency questionnaire measured child dietary quality; 5 items measured healthy foods/behaviours, and 8 measured discretionary foods/unhealthy behaviours, with a maximum score of 65(3). Linear regression assessed associations between child eating behaviour traits and dietary quality, including interactions between child eating behaviour traits and child age. Of the 1367 respondents, half of the children were male (50.2%) and the mean age of the children was 3.3 years (SD = 1.0). The mean child dietary quality score was 51.9 (out of 65, range 21 to 64). Enjoyment of food was positively associated with dietary quality (B coefficient: 2.51, p < 0.001), whilst food fussiness and satiety responsiveness were inversely associated with dietary quality (B coefficients: −2.59 and −2.25, respectively, p < 0.001), and food responsiveness was not related to diet quality. Child age moderated associations between food fussiness and dietary quality (B coefficient: −0.38, p = 0.025), but not the other eating behaviour traits. The difference in dietary quality between lower and higher food fussiness was most pronounced among 5-year-old children. In conclusion, the findings from this study suggests that future interventions targeting poor dietary quality of pre-school children should consider targeting children with lower food enjoyment or higher food fussiness or satiety as possible ways to improve child dietary quality. Future interventions should also have a particular focus on strategies to reduce food fussiness for older preschoolers, as well as fussiness prevention strategies for younger preschoolers.

Handgrip strength (HGS) is a marker of protein-energy status in people on haemodialysis (HD). Best practice guidelines recommend measuring HGS before the commencement of the dialysis session, which is not always possible(1). No previous research has compared the reliability, reproducibility and agreement of HGS values pre- and mid-dialysis. Here we aimed to determine the reliability, reproducibility and agreement of HGS values pre- and mid-dialysis. Participants were recruited from four HD units (n = 47). Eligible participants were stable on HD for at least 3 months and not acutely unwell. HGS was measured in triplicate on the non-fistula arm before dialysis (pre-dialysis HGS) and two hours into dialysis (mid-dialysis HGS) for three consecutive weeks. Wilcoxon signed ranked tests were used to determine the difference between pre and mid-HGS. Friedman tests with Dunn’s post hoc test were used to determine the repeatability of the HGS measures over three weeks. Bland Altman plots were used to determine the agreement between pre- and mid-measures. We observed that HGS measures taken pre- and mid-dialysis differed statistically (19.0 kg [IQR, 14.5–28.1] vs 19.9 kg [IQR, 15.0–28.4], p = 0.005), but not to a clinically relevant level(2,3). There were no significant differences in pre-dialysis HGS measures (p = 0.34) nor mid-dialysis HGS measures (p = 0.16) over the 3 weeks. Bland Altman plots indicated agreement between pre- and mid-dialysis HGS measures, suggesting no systematic bias in HGS. This study found that HGS taken at either pre- or mid-dialysis were reliable and reproducible. These data indicate reasonable agreement between pre- and mid-dialysis HGS measures. Mid-dialysis HGS is a valuable tool for monitoring changes in the nutritional status of HD patients, providing HGS is consistently measured mid-dialysis.

Increased temporal variability in the gut microbiome is associated with intestinal conditions such as ulcerative colitis and Crohn’s disease, leading to the recently established concept of microbial volatility (1). Increased physiological stress has been shown to increase microbial volatility indicating that microbial volatility is susceptible to external interventions(1). Dietary fibre positively affects the gut microbiome, but it is unclear if it impacts microbial volatility. The gut microbiota influences hypertension, and high-fibre intake reduces blood pressure (BP)(2). However, not all individuals exhibit a response to these fibre-based dietary changes, and the reasons for this variability remain unclear. Similarly, it is unknown whether the degree of stability of the gut microbiota consortium could be a determining factor in individual responsiveness to dietary interventions. Here, we aimed to identify: i) whether gut microbiome volatility differs when dietary fibre vs placebo interventions, and ii) whether microbiome volatility discriminates between BP responders and non-responders to a high fibre intervention. Twenty treatment-naive participants with hypertension received either placebo or 40g per day of prebiotic acetylated and butyrylated high amylose maize starch (HAMSAB) supplementation for 3 weeks in a phase II randomised cross-over double-blind placebo-controlled trial(3). Blood pressure was monitored at baseline and each endpoint by 24-hour ambulatory BP monitoring, with those experiencing a reduction between timepoints of ≥ 2 mmHg classified as responders. Baseline stool samples were collected, and the V4 region of the 16S gene was sequenced. Taxonomy was assigned by reference to the SILVA database. Microbial volatility between timepoints (e.g., pre- and post-intervention) was calculated as the Euclidian distance of centred log-ratio transformed genera counts (Aitchison distance). No difference was observed in microbial volatility between individuals when they received the dietary fibre intervention or the placebo (21.5 ± 5.5 vs 20.5 ± 7.7, p = 0.51). There was no significant difference between microbial volatility on the dietary intervention between responders and non-responders (21.8 ± 4.9 vs 20.9 ± 7.2, p = 0.84). There was no association between the change in BP during intervention and microbial volatility during intervention (r2 = −0.09, p = 0.72). These data suggest that temporal volatility of the gut microbiota does not change with fibre intake or contribute to the BP response to dietary fibre intervention trials in people with hypertension.

Pregnancy prompts a cascade of anatomical, metabolic, hormonal, and immunological adaptations important for foetal development, labour and birth(1). These multi–system adaptations interact with the maternal gut microbiome and may affect pregnancy and infancy outcomes(2). However, the nature and extent of changes to gut microbiome composition and diversity during pregnancy and the influence of dietary intake remains contentious. The ‘BABY1000’ pilot prospective birth cohort study based in Sydney, Australia(3) sought to explore associations between maternal diet, the maternal gut microbiome before and across pregnancy, and the infant gut microbiome. Primary aims were to (1) explore the composition and diversity of the gut microbiome of women at preconception, at 12-, 28- and 36-weeks’ gestation, and in infants at six weeks of age; and (2) determine how maternal and infant gut microbiomes are influenced by diet quality and fibre intake during pregnancy. Mothers (n = 146) and infants (n = 105), encompassing 86 mother–infant dyads were involved. RStudio (v 4.2.3) was used to perform microbiome composition and diversity analyses using 350 maternal and 102 infant stool samples. Maternal dietary quality was assessed at recruitment (preconception or 12 weeks’ gestation) and at 36 weeks’ gestation using the Australian Eating Survey (AES)(4). At the group level, maternal dietary quality was suboptimal and did not change significantly across pregnancy (mean scores of 37.5 ± 7.3 and 38.3 ± 6.7 out of 73 points at recruitment and late pregnancy, respectively; p > 0.05). Although differences in gut microbiome alpha (within–person) diversity between mothers and infants was highly significant (p < 0.0001), no differences in gut microbiome composition or diversity related to pregnancy status or gestational stage were observed. Maternal diet quality in pregnancy was also not significantly correlated with microbial beta (between–people) diversity in samples taken in late pregnancy (PERMANOVA: R2 = 0.039, p > 0.05). When fibre intake was separated into quartiles, there was a significant (p < 0.01) difference in alpha diversity between the lowest and highest quartiles of intake, though differences in beta diversity were not significant (PERMANOVA: R2 = 0.06, p > 0.05). Microbiota composition and diversity in infant samples was also not significantly affected by maternal dietary quality or fibre intake, but rather by birth mode and feeding type. Significantly different clustering of infant samples was clear between vaginal and caesarean births (PERMANOVA: R2 = 0.029, p = 0.005). Gut bacterial alpha diversity was significantly lower (p < 0.01) between infants receiving breastmilk compared to formula. As this area of research is still in its ‘infancy’, appropriately powered longitudinal studies are required to understand the processes that shape diet and microbiome interactions during the critical first 1,000 days of life and beyond.

Chronic musculoskeletal pain (CMP) often disrupts daily activities, including dietary behaviours, which may lower overall diet quality(1). This study aimed to explore the extent to which participants with CMP perceived pain influences their eating behaviours and evaluate how diet quality is impacted during pain episodes. Twenty-five participants (72% women, 55 ± 16 years, 25.4 ± 4.6 kg/m2) were enrolled in a 2-week feasibility study, with scientific and exploratory outcomes reported(2). Clinic assessments captured pain sites, baseline pain intensity (0–100 mm Visual Analogue Scale, VAS), and thoughts and feelings evoked by pain (Pain Catastrophising Scale, PCS). Eating behaviours were assessed using the Dutch Emotional Eating Behaviours Questionnaire (DEBQ-E) and study-specific Food-Related Behaviours Questionnaire (FBQ). Participants completed 4-day weighed food records (WFR) and reported pain (via VAS) concurrently at each eating occasion. Daily pain intensity was obtained by averaging VAS at each eating occasion. Using a novel algorithm, diet quality was scored from WFR (FoodWorks, Xyris) data using the Dietary Guideline Index (DGI), generating total (0–120), core (0–70) and non-core scores (0–50) for each day’s intake, and averaged for the 4-days(3). Higher DGI scores reflect better diet quality. Spearman rho (rs) explored associations between baseline pain and diet outcomes. Linear mixed-effects (LME) models explored whether daily pain intensity (VAS) predicted fluctuations in diet quality (DGI scores). The FBQ responses were reported descriptively. Most participants (84%) reported multiple pain sites, with mild-moderate intensity (initial VAS, 40.8 ± 23.0) and poor diet quality (DGI total score 51.6 ± 18.0). Higher baseline pain intensity was associated with lower average DGI core food scores (rs −0.470, p = 0.018). Higher PCS scores correlated with lower average DGI total, and core food scores (rs −0.397, p = 0.049 and rs −0.442, p = 0.027), and higher DEBQ-E scores (rs 0.521, p = 0.008). However, when captured concurrently with dietary intake, LME models indicated that average daily pain intensity, which varied across the 4-days (VAS range: 0.8–85.0) did not significantly predict daily diet quality (DGI total, core, or non-core scores). Most participants disagreed that pain influenced their dietary behaviours (40–84% disagreement), with the highest agreements (31%) for choosing less healthy foods and snacking more frequently when in pain. This study suggests dietary behaviours are associated with CMP, with lower core food intake related to higher pain intensity, and emotional eating associated with pain catastrophising. The concurrent assessment of diet quality and pain intensity provided a novel approach to explore these relationships. However, although we observed fluctuations in pain intensity, these did not influence dietary intake and associated diet quality. This study highlights the importance of capturing diet quality and dietary behaviours in people with persistent pain.

Evidence supports plant-based dietary patterns for preventing cardiovascular diseases (CVD)(1). Fat mass is a strong predictor of CVD(2), however it’s unclear whether this mediates the relationship between plant-based dietary patterns and CVD. Hence, the aim of this study was to determine if longitudinal associations between plant-based dietary patterns and incidence of CVD events, CVD mortality and all-cause mortality are mediated by fat mass in mid-life. Dietary data (Oxford WebQ) from 14,247 adults (median 56 years [IQR 49–61]) in the UK Biobank cohort study were used to derive diet quality index scores for an overall plant-based diet (PDI), a healthy plant-based diet (hPDI), and a less healthy plant-based diet (uPDI). Health registries and national records provided CVD event and mortality data. Percentage fat mass was measured by dual X-ray absorptiometry. Cox proportional hazard ratios (95% CI) identified associations between each diet quality index and CVD events, CVD mortality or all-cause mortality. Regression-based mediation analysis was used to identify the direct effect (plant-based diet quality indices on CVD mortality, CVD events, or all-cause mortality), and the indirect effect, which was mediated by fat mass. New CVD events (n = 364), CVD mortality (n = 52) and all-cause mortality (n = 220) were identified with mean follow up of 11.6 (SD ± 0.4) years for CVD events, and 11.5 (SD ± 0.7) years for mortality. The mean score for PDI was 50.5 (SD ± 5.9), hPDI 52.8 (SD ± 7.2), and uPDI 54.0 (SD ± 6.8). The PDI and hPDI were inversely associated with fat mass, and the uPDI was positively associated with fat mass (p < 0.001). There was no association between the diet quality indices and health outcomes, with (direct effect) or without (total effect) the fat mass mediator for males and females (p ≥ 0.1). Fat mass was associated with risk of mortality in some models, after controlling for the indices, such as a lower risk of all-cause mortality after controlling for the hPDI (p < 0.1). There was a significant negative indirect effect of hPDI on CVD mortality via fat mass for females only (observed coefficient 0.81; 95% CI 0.60–0.99). Overall, there was limited evidence of a mediating effect from fat mass in the association between plant-based dietary patterns and incidence of CVD events, CVD mortality and all-cause mortality. Studies with larger samples and longer follow up are needed to determine whether the mediating effect of fat mass on hPDI and CVD mortality in females is reproducible.

Eggs are a unique food that are high in cholesterol, but low in saturated fat. Egg consumption recommendations have fluctuated over time due to the belief that increased intake of dietary cholesterol raises plasma low density lipoprotein cholesterol (LDL-C) and therefore cardiovascular disease risk(1). Research suggests it is saturated fat, rather than dietary cholesterol, that is implicated in this association, yet controversy over egg consumption remains(1,2). This study aimed to evaluate the independent effects of dietary cholesterol (from eggs) and saturated fat intakes on LDL-C. Sixty-one adults with LDL-C less than 3.5 mmol/L (39 ± 2 years, BMI 25.8 ± 0.8 kg/m2) were enrolled in a randomised controlled counter-balanced, three-arm cross-over study(3). Participants consumed three isocaloric diets for five weeks each in randomised order: a high-cholesterol (600 mg)/low-saturated fat (6%) diet including two eggs per day (EGG) diet, a low-cholesterol (300 mg)/high-saturated fat (12%) without eggs (EGG-FREE) diet, and a control diet (CON) high in both cholesterol (600 mg) and saturated fat (12%) including one egg per week. Each diet phase included eight detailed daily meal plans with recipes, which were used on rotation for the five-week period. Throughout each dietary phase participants attended three diet review consults (via video conference or phone) and received individualised dietary advice from a dietitian. Dietary intake (5-day diaries analysed using Foodworks, Xyris Software, Australia), and lipid and lipoprotein levels were measured at study entry, and at the end of each diet phase. Treatment effects were analysed using linear mixed effects models. Results are reported as mean ± standard error. Forty-eight participants completed all three diets, with dietary analyses demonstrating target cholesterol and saturated fat intakes were generally met for each diet. Notably, saturated fat intake was 2% higher than target for all diets (CON and EGG 14%; EGG-FREE 8%). Compared to CON, plasma LDL-C concentration was significantly lower following the EGG diet (2.83 ± 0.08 mmol/L vs 2.68 ± 0.08 mmol/L, p = 0.02), but not the EGG-FREE diet (2.75 ± 0.08 mmol/L, p = 0.52). Across all three diets there was a significant within-individual relationship between dietary saturated fat intake and LDL-C concentration (β = 0.35, p = 0.002), but there was no significant relationship with dietary cholesterol intake (β = −0.006, p = 0.42). Our findings indicate that dietary saturated fat, not cholesterol, is responsible for elevating plasma LDL-C concentrations. Consuming two eggs per day within a low-saturated fat diet does not adversely affect plasma LDL-C.